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Men with prostate cancer want screening despite doubts over effectiveness of treatment

Why men with prostate cancer want wider access to prostate specific antigen testing: qualitative study BMJ Volume 325, pp 737-9


Most men with prostate cancer strongly advocate routine testing for prostate specific antigen (PSA), despite evidence that aggressive screening and treatment does not reduce deaths, according to two studies in this week's BMJ.

In the first study, researchers at the University of Oxford interviewed 52 men with suspected or confirmed prostate cancer.

All but four men were keen to see others, including their own friends and sons, have a PSA test. Their reasons included the belief that early diagnosis would reduce death, improve quality of life, and save the NHS money. The four men who opposed screening knew that treatment had not been proved effective and accepted that this was a deterrent to screening.

Screening for prostate cancer has serious disadvantages, say the authors. As such, general practitioners in the UK have been advised to ensure that men who have a PSA test are making an informed choice. Policy makers, politicians, and doctors need to understand why people want wider access to PSA testing so that they can find better ways of communicating information about risk, they conclude.

In the second study, researchers in the United States compared the Seattle-Puget Sound region, where intensive screening and treatment for prostate cancer were adopted early, and Connecticut, where adoption was slower.

During 1987-90, men in Seattle were five times as likely to undergo PSA testing and twice as likely to undergo biopsy. Rates of radical surgery and radiotherapy were also substantially higher. However, over 11 years of follow up, prostate cancer death rates were similar in the two areas.

Longer follow up may be necessary to fully assess the outcome of this natural experiment, say the authors. Meanwhile, ongoing trials assessing the effectiveness of screening and treatment for prostate cancer should be supported.


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